Drug allergy labels and complications after surgery: a prospective multi-centre cohort study
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Background
One in four surgical patients carries a drug allergy label, of which an estimated 90% are incorrect. Avoidance of first-choice drug therapies may lead to worse postoperative outcomes. We sought to determine the nature and extent of any association between drug allergy labels and postoperative complications.
Methods
A multicentre observational study in 21 NHS hospitals. Eligible patients were ≥18 years, undergoing common surgical procedures: primary hip or knee replacement; internal fixation of closed long bone fracture; colorectal resection; trans-urethral resection of prostate or bladder tumour; caesarean section; hysterectomy. Exclusion criteria: use of antibiotics in the two weeks prior to surgery, previous participation in the study. Primary outcome was postoperative complications within 30 days following surgery, a composite outcome comprising: all postoperative infections, anastomotic leak, acute respiratory distress syndrome, myocardial infarction, postoperative bleed, pulmonary embolism, stroke, antimicrobial side effects, death.
Results
Among 13,646 patients, 3924 (29%) carried ≥1 drug allergy labels. Labelled patients were more likely to develop postoperative complications (989/3924 (25%) vs 1926/9722 (20%); OR 1·21 [1·10-1·34]; p<0·001). They were more likely to develop surgical site infections (337/3924 (9%) vs 760/9722 (8%); OR 1·19 [1·03 -1·38]; p<0·018), and any postoperative infection (750/3924 (19%) vs 1472/9722 (15%); OR 1·24 [1·11-1·38] p<0·001). Labelled patients experienced increased risk of allergic drug reactions (31/3924 (0·01%) vs 29/9722 (<0·01%); OR 3·00 [1·77-5·09]; p<0·001), but no increase in mortality.
Conclusions
Drug allergy labels are common, but often incorrect. Labelled patients experience worse postoperative outcomes, including infective and non-infective complications and increased risk of allergic drug reactions.
Trial registration
Registered with ISRCTN registry, ISRCTN15775657 .
